This article was co-authored by Eduardo Montaña, MD, MPH. Dr. Montaña is a Pediatrician in Georgia. He received his MPH and MD from Emory University in 1985 and 1989.

There are 18 references cited in this article, which can be found at the bottom of the page.

Hormonal imbalance can impact, if not directly cause, acne. Although, adolescents are the age group most commonly thought to struggle with acne, " adult-onset acne" is also a significant problem for many, especially women in their 20s, 30s, 40s and even 50s. There are a number of approaches you can take to balance your hormones and treat your acne safely and effectively, including medical treatment and lifestyle changes and natural remedies. Explore your options with the help of your doctor or dermatologist to choose the best approach to treat hormonal balances that may contribute to acne.

Steps

Method1

Treating Hormonal Acne Medically

1

Use oral contraceptives. If acne is thought to be complicated by a hormonal imbalance, your dermatologist may choose hormone replacement therapy (HRT) as part of the treatment. The most common HRT for acne is contraceptive therapy using birth control pills. These often contain estrogens, progestins or both in varying concentrations. The type and dosing of oral contraceptive is an important factor in acne treatment, and only a dermatologist specialized in their usage for this condition should be treating acne with HRT. The use of HRT may be very effective in young women. Sometimes another hormone, spironolactone, is also added.[1][2]

Treatments with oral contraceptives can help some women with hormonal acne, but can have significant side effects. Side effects may include dizziness, headaches, weight changes, stomach upset, bloating, nausea, depression, chest pain, increased risk of heart disease (especially in women who smoke), shortness of breath, lumps in the breast, and liver problems.

These drugs have also been implicated in increasing the risk of breast cancer, deep vein thrombosis, and strokes. There doesn’t appear to be much difference in which oral contraceptive is used.[3] Keep in mind that the biggest risk factors for women taking HRT is obesity, smoking, lack of physical activity and a history of clotting disorders. Like most medical treatments, inform yourself fully about the risks and benefits of the treatment in consultation with a qualified medical professional.

2

Consider bioidentical hormones. Bioidentical hormones are synthetic hormones that are most commonly used as topical treatments, but they are increasingly being used to treat hormonally-related acne. Bioidentical hormones are often recommended by naturopathic providers and are available over-the-counter. It is very important to note that these are non-regulated, meaning there is no standard or testing for quality or purity before they are released on the market and they may be manufactured without following pharmaceutical standards. While their chemical compounds are labeled as “chemically identical” to your own human hormones, no medically sound research determining the risks and benefits of these compounds exist. Premarin, for example, is derived from the urine of pregnant female horses.[4][5]

Before taking a bioidentical hormone, you should speak with a dermatologist who can order tests to determine your individual hormone levels and determine the specific hormones to be replaced to restore your body to normal physiologic levels. Monitoring of the hormone levels and any potential side effects is also a crucial part of treatment.

3

Understand the risks of hormone replacement therapy. With any form of hormone replacement therapy, the risks and benefits have to be weighed; you should do so with your doctor. Using oral contraceptives increases the risk of cervical, breast, and liver cancers, heart disease, and stroke.[6]

It has been reported that bioidentical hormones have been used safely in Europe for over 50 years to treat menopause, but there may still be risks associated with these hormones when used over a long time period and when used to treat acne, which has not been studied extensively. Exercise caution with any non-medical treatment that has not been studied using strict scientific methods to determine safety and effectiveness

The best advice is to consult your medical professional before using any treatment, including HRT, and to do so only under the supervision of that medical provider.

Method2

Balancing Your Hormones Naturally

1

Eat a diet high in omega-3s. Healthy and therapeutic lifestyle choices remain the mainstay of sensible treatment for most chronic conditions, including acne. Consuming recommended doses of omega-3 fatty acids can benefit those with hormonally-related acne. Polycystic ovary syndrome (PCOS), a disorder associated with hormonally-related acne, may be effectively treated in part by switching to a diet high in omega-3 fatty acids and other anti-inflammatory foods. Food high in omega-3 fatty acids include:

Incorporate more vitamin A and D into your diet. Vitamin A and vitamin D can help you treat your hormonal acne. They help balance hormones and promote skin health. You can take a supplement, but you can get your daily values from food. You can get enough vitamin D by spending 15 minutes in the sun.

Foods rich in Vitamin D include fish and cod liver oil, and dairy, like milk, yogurt, and cheese. Many foods are fortified with vitamin D.[8]

3

Talk to your doctor about using herbs to help balance acne. There are a number of different herbs that may be useful in rebalancing hormones in women with hormonal acne. For all the herbs listed, follow manufacturer’s instructions and always talk to your physician to determine if there may be interactions with any medications you may currently be taking.[9]

Consult with your doctor or a pharmacist for recommended brands when taking supplements. The supplement industry is not regulated by the FDA, so their purity and effectiveness has not been scientifically proven. Ask a medical professional about reputable brands.

Vitex agnus-castus or chasteberry is an herb traditionally used to balance female hormones. It has been shown very useful in treating Premenstrual Dysphoric Disorder (PMDD) as well as Premenstrual Syndrome (PMS) and has been used to effectively treat hormonal acne.[10][11]

Maca is a root vegetable and has been traditionally used in South American native medicine. It has phytoestrogenic activity and may increase progesterone levels.[12]

Dong quai or Angelica sinensis is an herb used in Traditional Chinese Medicine (TCM) and is known as a female ginseng. It has anti-inflammatory effects that may be helpful. Dong quai is commonly used during menopause to treat menopausal symptoms. It may promote progesterone secretion and inhibit estrogen secretions.[13]

Black cohosh or Cimicifuga racemosa is another herb traditionally used to balance female hormones, primarily during menopause, where it has been shown to be effective in reducing menopausal symptoms. Black cohosh has phytoestrogenic effects and has been used topically to treat hormonal acne.[14]

Method3

Understanding Hormonal Acne

1

Learn what causes hormonal acne. Many teenage and older women find that their skin gets worse right before their menstrual cycle, usually about 10 days before the period begins. Any acne that can be aggravated during different times of the menstrual cycle can be called hormonal acne.[15]

In the first half of the menstrual cycle, the prominent reproductive hormone is estrogen, and in the second half, the prominent hormone is progesterone, which stimulates the production of sebum. Additionally, the relative levels of testosterone increase, which stimulates even more sebum production.

In some young girls and women, the balance between these hormones is such that acne can flare up in those days before the period begins. In some, that balance can signal significant problems with the reproductive system while others will re-balance without using any hormonal treatment.[16]

2

Identify the symptoms of hormonal acne. Hormonal acne has a specific pattern so that you know when it’s going to pop up. This breakout usually occurs around the time of the menstrual cycle. Hormonal acne usually appears under the cheekbones and around the chin and mouth.[17]

Hormonal acne is generally painful, large, with pockets of pus. It’s usually resistant to any type of treatment.

3

Determine the causes of acne. It is not always clear why acne occurs. Hormonal acne can be caused by an underlying condition, such as Polycystic Ovarian Syndrome (PCOS). A few common reasons for acne include reactions or sensitivities to chemicals in cosmetics or personal products, smoking, or sensitivity to dairy products and highly processed and sugary foods. It may also be due to inflammation from an underlying condition or bacterial infections.[18]

High levels or excess activity of the male hormone testosterone can cause acne. This can occur during the second half of the menstrual cycle. It is not necessarily a problem of too much testosterone; it may just be a matter of too much testosterone as compared to the levels of estrogen and progesterone.

Reduced fatty acid levels in the skin due to not enough essential fatty acids in the diet may also cause acne.

Acne commonly occurs in both male and female teens and young adults, but more women in their 30s, 40s, and 50s are getting acne

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